呼吸病房下呼吸道感染病原菌及药敏现状分析

Antibiotic susceptibility of clinical isolates from lower respiratory tract infection in patients in respiratory ward

目的了解该院呼吸病房住院患者下呼吸道感染病原菌分布及药物敏感情况。方法收集2003年1月～2004年12月该院呼吸病房下呼吸道感染住院患者痰菌(或纤维支气管镜吸取分泌物)培养阳性标本结果进行回顾性统计分析。结果分离出细菌20余种共522株,革兰阴性杆菌411株(78.7%),主要为铜绿假单胞菌、流感嗜血杆菌、不动杆菌、副流感嗜血杆菌和克雷伯菌;革兰阳性球菌111株(21.3%),主要为表皮葡萄球菌、肺炎链球菌及金黄色葡萄球。流感及副流感嗜血杆菌对三代头孢菌素敏感;铜绿假单胞菌、不动杆菌、克雷伯菌对美洛培南、舒普深、头孢吡肟敏感,对三代头孢菌素敏感性较差;葡萄球菌对万古霉素均敏感;肺炎链球菌对美洛培南、左氟沙星敏感性好,对青霉素大部分耐药。结论下呼吸道感染以革兰阴性杆菌感染为主,且常见病原菌耐药现象较严重,临床上应合理应用抗生素以延缓细菌耐药性的产生。

[Objective] To investigate the pathogenic bacteria distribution and susceptibility of lower respiratory tract infection in patients in our respiratory ward. [Methods] All the clinical isolates from sputum or secretion of lower respiratory tract from 2003 to 2004 were analyzed retrospectively. Antibiotic susceptibility was tested by Kir- by-Bauer method. Results were interpreted according to NCCLS 1998. [Results] A total of 522 clinical isolates were collected, including 411 strains of gram-negative bacilli （78.7%） and 111 strains of gram-positive cocci （21.3%）. The most important pathogens in gram-negative bacilli were Pseudomonas aeruginosa, Haemophilus, Acinetobacter and Klebsiella; the most common pathogens in gram-positive cocci were Staphylococcus epidermidis, Streptococcus pneumoniae and Staphylococcus aureus. Pseudomonas aeruginosa, Acinetobacter and Klebsiella were susceptible to meropenem, sulperazone and cefepime, while resistant to the third generation of cephalosporin. In gram-positive cocci, Staphylococci were all susceptible to vancomycin; Streptococcus pneumoniae were highly susceptible to meropenem and levofloxacin, while they were highly resistant to penicillin. [Conclusion] Infection caused by gram-negative bacilli was predominant in lower respiratory tract infection patients. Antibiotics resistance of some pathogens became more and more severe. Therefore, the rational use of antibiotics is important for the containment of bacterial resistance.